You are on page 1of 57

Guidance for nurses and midwives in practice development units who are

involved in the education of staff in the preparation and administration of


injections in near- patient areas.

August 2007
Review Date August 2008

1
Contents Page Number
Introduction 3
The scope of this guidance 3
Structure and use of the guidance 4
Aim of this guidance document 5
Process for the development of this guidance 6
Format of the quality educational framework 6
Section A The Quality Educational Framework
Topic 1. Preparation the injection: responsibilities of staff (e.g. nurses, doctors and pharmacists) 8
Topic 2. Hazards involved in the preparation of injections 14
Topic 3. Calculations and checking procedures during the preparation of injections 18
Topic 4. Drug incompatibilities 20
Topic 5. The stability of prepared injections 22
Topic 6. Displacement values of injections 23
Topic 7. Aseptic technique for the preparation of injections 24
Topic 8. Standard preparation methods for preparing injections 26
Topic 9. Checking procedures prior to, and during administration of injections 28
Topic 10. Documentation for the preparation and administration of injections 30
Topic 11. Labelling requirements for injections 32
Topic 12. Disposal of waste, including medicines, containers and sharps 33
Topic 13. Product monographs 35
Topic 14. Awareness of the Control of Substances Hazardous to Health (COSHH) and other 35
safety considerations
Section B Examples of practice 39
Section C Examples of minimum information for inclusion in educational programmes 42
Acknowledgements 48
Appendices
Appendix I References 49
Appendix II Glossary of terms 50
Appendix III Membership of the steering group and reference groups 53
Appendix IV Respondents to the consultation 55

2
Introduction

Improving the patient experience is at the heart of the National Health Service. Standards and quality of care must remain consistently high, regardless of
who performs a clinical intervention and where it is performed. The preparation of injections in the near-patient area, defined as the area where the patient is
examined, treated and cared for in clinical settings and patient homes, should be carried out by suitably educated healthcare staff in a suitable environment,
using safe procedures. Healthcare professionals need to be educated in the preparation of injections in near-patient areas as this is where the majority of
injections are prepared prior to administration. This education should take the form of a dedicated competency based training programme. The training should
be available for all members of the healthcare team who are required to prepare and administer injections in near - patient areas, for example nurses, doctors
and pharmacists. Following attendance at an initial educational course, the competence of practitioners should be reassessed on a regular basis (e.g. every 3
years).

Rationale for development of the guidance


This guidance document has been developed to support the implementation of the publication from The Scottish Executive Clinical Resource and Audit
1,2
Group (CRAG) Good Practice Statement for the Preparation of Injections in Near-Patient Areas, Including Clinical and Home Environments. It expands on
each of the topic areas in Appendix 6 of the publication, ‘Example training programme for the preparation of injections.’

The scope of this guidance

This guidance was developed using current course programmes, course workbooks and other documentation submitted by practitioners who are currently
involved in the education of practitioners within secondary care in NHS Scotland.

Who is the guidance for?


This guidance document is primarily directed at those practice educators who currently provide, educational courses on the preparation and administration of
injections in near - patient areas. However, this guidance document may be relevant to other professionals (e.g. doctors and pharmacists).
It is intended to provide a framework to facilitate the development and review of current training courses for the preparation and administration of injections
within NHS Scotland.

Additional education will be required for high risk injections, (e.g. chemotherapy, intrathecal and epidural injections) and for high risk patient groups, (e.g.
paediatric patients).

3
Structure and use of the guidance document

This guidance document comprises of three sections:

Section A shares the educational framework, in 14 distinct sections. Each section details the various topics that need to be included in a local
educational programme to ensure compliance with the CRAG publication ‘Good Practice Statement for the Preparation of Injections
2
In Near-Patient Areas, Including Clinical and Home Environments’. Preceding, each topic are key references with web links which
enable educators and practitioners to access the a wide variety of underpinning knowledge that support of the various competencies.

Section B shares information on current practice throughout Scotland. This information was submitted during the scoping exercise.

Section C details the minimum underpinning knowledge that should be provided within a local educational programme.

The purpose of this guidance is to provide a foundation for the further development of good practice and to facilitate consistency in the approach to the
teaching about the preparation and administration of injections in near-patient areas. It is designed to complement, support and strengthen a range of quality
assurance measures already in place within NHS Scotland. By following this guidance practice educators will facilitate the ‘transfer of skills’ for the
preparation of injections in near - patient areas between organisations and Health Boards throughout Scotland.
3
The guidance document is one of a number of publications to support the education and training of the healthcare team in Scotland. A number of staff from
clinical practice and education were involved in development of this guidance and their contribution is acknowledged.

The development of this guidance has been facilitated by NHS Education for Scotland (NES) in liaison with NHS Quality Improvement Scotland and key
partners within the service.

References
Please see Appendix 1 for members of the reference group for development of this document.

4
Aim of the guidance

As stated by SEHD within Good Practice Statement for the Preparation of Injections in Near - Patient Areas, including Clinical and Home Environments, any
training provided should consist of as a minimum, information relating to:

o the reconstitution of medicines


o the compatibility/incompatibility of medicines with infusion fluids
o the limits on the concentration of the final solution prior to administration
o the stability of the final product
o rates of administration of medicines
o the compatibility of medicines with other medicines during the administration process

At all stages of the preparation and administration process injections must be clearly identifiable. This should be achieved through clear, accurate labelling of
the product or by a locally agreed documented system.

NHS Scotland staff who have responsibility for developing and delivering education and training in the preparation of injections in near-patient areas, are
encouraged to use this guidance to:

○ map existing educational programmes to the recommendations as detailed in HDL (2002) 91 Good Practice Statement for the Preparation of Injections
2,3,4
in Near - Patient Areas, Including Clinical and Home Environments

○ amend current educational programmes in light of the above

○ design, develop and deliver new improved educational programmes for the training of healthcare practitioners within their local area

○ be informed of aspects of practice as identified from the scoping exercise undertaken as part of this project

5
Process for development of the guidance

This framework was developed by:

o reviewing the content of local training programmes, local educational frameworks and recognised reference sources provided as part of the
scoping exercise for this project

o consulting with multi disciplinary steering and reference groups specifically convened for this project

Format of the quality educational framework

The quality educational framework an overview

The quality educational framework consists of a variety of quality standards which have been designed to articulate the professional standards required as
1
detailed within The Health Department Letter (HDL (2002) 91 and the document ‘Good Practice Statement for The Preparation of Injections in Near-Patient
2
Areas, including Clinical and Home Environments .

The quality educational framework (Sections A, B and C)

Section A: The competency framework details the various competencies that practitioners should be able to achieve after attending a local training session.
The competencies provide the educator with topics that are required to be included should they wish the local training programme to reflect the
various requirements as detailed in the CRAG document. Key reference sources are detailed and web links provided where possible.
Some references require a subscription to a specified nursing journal and others may be located through the e – library.

Under each topic the relevant elements for inclusion in a local training programme are detailed. In relation to each element, Suggestions for demonstration of
achievement of the various elements of training are proposed. Achievement may be by achieved by e.g. attending a training session and/or by self directed
reading.

Section B: Details examples of practice that were identified from the ‘scoping exercise’ that was undertaken as part of this project.

Section C: Details suggested minimum information that should be included as part of the underpinning knowledge within the delivery of the local educational
programmes.

6
Skills for health

http://www.skillsforhealth.org.uk/page/competences/completed-competencies-projects/list

Where possible the competencies have been mapped to the various skills for health.

CHS 3 Administer Medication to individuals http://www.skillsforhealth.org.uk/tools/get_competence.php?id=2551


CHS 23 Carry out intravenous infusion http://www.skillsforhealth.org.uk/tools/get_competence.php?id=2574

7
The Quality Educational Framework

Section A
Topic 1
General Underpinning Knowledge Access the e - library website
http://www.elib.scot.nhs.uk/portal/elib/pages/index.aspx?referer=AAS&un=nousername

Topic 1: Preparation of the Injection- responsibilities of staff General Underpinning Knowledge/Directed Reading

The Scottish Executive Health Department (2002)


Good Practice Statement for The Preparation of Injections in Near-Patient Areas, http://www.scotland.gov.uk/Publications/2002/12/16049/15908
including Clinical and Home Environments, Edinburgh:SEHD

The National Patient Safety Agency (2007) http://www.npsa.nhs.uk/site/media/documents/2602_0434_injectables_meds_alert_v


Promoting safer use of injectable medicines: Patient safety alert 20, London 20.pdf

The Royal Pharmaceutical Society (2005) http://www.rpsgb.org/pdfs/safsechandmeds.pdf


The Duthie Report: The safe and secure handling of medicines. A Team Approach :
London.

Nursing and Midwifery Council


The NMC Code of Professional Conduct: Standards for Conduct, Performance and http://www.nmc-uk.org/aFrameDisplay.aspx?DocumentID=201
Ethics. Standards 07 04 Published November 2004

Guidelines for Records and Record Keeping Guidance 01 05 Published 2005 http://www.nmc-uk.org/aFrameDisplay.aspx?DocumentID=516

A-Z Advice Sheet The Administration of Medicines 2004 Last Updated July 2006 http://www.nmc-uk.org/aFrameDisplay.aspx?DocumentID=1801

The Office of Public Sector Information http://www.opsi.gov.uk/legislation/scotland/acts2000/20000004.htm


Adults with Incapacity (Scotland Act) 2000. Scottish Statutory Instrument 2003
No. 516 (C.28), Edinburgh: Crown Copyright.

The Royal College of Nursing.


St Standards for Infusion Therapy. 2005 www.nmc-uk.org.uk

8
Nursing Standard 2005
Ingram P, Lavery I (2005) Peripheral intravenous therapy: key risks and implications www.nursing-standard.co.uk/archives/ns/vol1946/pdfs/v19n46p5564.pdf
for practice. Nursing Standard, 19 (46) 55-64.

Nursing Standard
Hyde, L. (2002) Legal and professional aspects of intravenous therapy.
Nursing Standard , 16 (26): 39-42.
www.nursing-standard.co.uk (Archives) Please note that you need to be registered
with Nursing Standard to access this article

The British Journal of Nursing


Knowledge of Principles for the correct administration of medicines http://www.britishjournalofnursing.com/
Dimond, B. ( 2003 ) Principles for the correct administration of medicines. Part 1.
British Journal of Nursing: 12 (11): 682-685.

Knowledge of Principles for the correct administration of medicines


Dimond, B. ( 2003 ) Principles for the correct administration of medicines. Part 2.
British Journal of Nursing: 12 (12): 760-762..

The Department of Health


An Organisation with a Memory (2000) Report of an expert group on learning from http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAnd
adverse events in the NHS. London: DH Guidance/Browsable/DH_4098184

Underpinning Knowledge for Specific Competencies

Competency 1.4
Medicines, Ethics and Practice: A Guide for Pharmacists Medicines for Human Use http://www.rpsgb.org.uk/pdfs/MEP30s1-2a.pdf

Competency 1.6 Local policies/guidance for the:


 Reporting mechanisms for the preparation of injections

Competency 1.7/1.8 Local policies/guidance that encompass the :


 Preparation and administration of medicines
 Switching from intravenous to oral preparations
 Prescribing of antibiotics
 Administration of parenteral medicines (e.g. status epilepticus)

9
Competency 1.10 Local Policies and Procedures for obtaining consent from a patient

The Department of Health(2001) Good Practice in Consent Implementation


Competency 1.11 Guide: Consent to Examination or Treatment, London: DH
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAnd
Guidance/DH_4005762

The Electronic Medicines Compendium www.emcmedicines.org.uk

Local policies or training sessions for the :

 Reporting of Adverse Events and Medication Incidents


 Preparation and Administration of Medicines (in particular , injections)
 Monitoring of Infusions and Infusion Devices

Dougherty, L. (2002) Intravenous Therapy in Nursing Practice. Churchill Livingstone.

Finlay, T. (2003) Intravenous Therapy. Blackwell Publishing. Oxford.

Curran, E.(2001) Reducing the risk of Healthcare Acquired Infection Nursing


Standard ,16 (1), 45-52.

McCulloch, J. (1999) Risk Management in Infection control Nursing Standard (1999)


13 (34) 44-46

Competency 1.12 The Yellow Card Scheme


http://www.mhra.gov.uk/home/idcplg?IdcService=SS_GET_PAGE&nodeId=287.

Significant Event Analysis www.nes.scot.nhs.uk/sea

Local /professional policies for :


 The reporting of adverse events/medication incidents
 CPD

Supporting Nurses and Midwives Through Life Long Learning Published 04/02
http://www.nmc-uk.org/aFrameDisplay.aspx?DocumentID=519
Competency 1.13
The Department of Health ( 2004 )The NHS Knowledge and Skills Framework and
the Development Review Process, London:DH
www.paymodernisation.scot.nhs.uk/afc/ksf/docs/ksf%20handbook.pdf

10
Section A
Competency Framework
Topic 1: Preparation of the Injection- Responsibilities of Staff (e.g. nurses, doctors and pharmacists)
Learning Outcomes Learning Method How Competence is Assessed

1.1
Be able to discuss the legal, ethical and Directed reading + Completion of individual professional CPD record
professional issues that need to be Local course for the preparation of Assessment by experienced practitioner during period of supervised practice
considered when a practitioner prepares injections
or administers an injection

1.2
Be able to describe the role and Directed reading + Completion of individual professional CPD record
responsibility of a practitioner when Local course for the preparation of Assessment by experienced practitioner during period of supervised practice
preparing /administering an injection injections

N.B. A medicine should only be administered


by injection, when no other viable route of
administration is available

1.3
Be able to describe the procedures that Directed reading + Assessment by experienced practitioner during period of supervised practice
the practitioner must follow to ensure Local course for the preparation of
that administration of a medicine by injections
injection is in the best interest of the
patient and is the most appropriate route
for the drug and the dose prescribed

1.4
Be able to describe the reasons for the Directed reading + Written report or testimonial
development of standard procedures for Local course for the preparation of +
the preparation of injections and the injections Appropriate completion of documentation during period of supervised practice
reasons for using standard,
documentation when prescribing,
preparing or administering injections

11
1.5
Be able to describe organisational Directed reading + Appropriate completion of related local documentation
personnel reporting structures and the Local course for the preparation of
documentation required when a injections
practitioner prepares/ administers an
injection

1.6
Be able to describe the reasons for Local course for the preparation of Assessment by experienced practitioner during period of supervised practice
‘regular ‘ (e.g. annual), audit of the injections
practice of preparing injections within the
vicinity of the patient and be able to
describe the documentation required in
order to undertake such an audit

1.7
Be able to describe the rational for the Directed reading + Testimonial following assessment during supervised practice
prescribing of at least 3 different types of Local course for the preparation of
injections by a practitioner and be able to injections
justify that the prescription is in the best
interest of the patient

1.8
Be able to describe the duty of care of Directed reading + Written report or testimonial
the practitioner when they prepare or Local course for the preparation of
administer an injection injections

i.e. the considerations when selecting an


appropriate route of administration

1.9
Be able to describe the local procedure Directed reading + Testimonial following observation during period of supervised practice
to be followed to obtain appropriate Local course for the preparation of
consent from a patient injections

1.10
Be able to describe the practitioner’s role Local course for the preparation of Written report or testimonial after period of supervised practice
in the monitoring of the patient prior to, injections
during and after administration of an
injection

12
1.11
Be able to describe the local procedure Directed reading + Written report or testimonial after period of supervised practice
for the reporting of adverse events or Attendance at local training sessions
medication incidents and be able to
identify the documentation required for
the reporting of such an event/incident

1.12
Be able to demonstrate continued Directed reading + Annual PDP meeting
competence Attendance at the local course for the
preparation of injections Assessment every 3 years

13
Section A
General Underpinning Knowledge
Topic 2

Topic 2: Hazards involved in the Preparation and Administration of General Underpinning Knowledge/Directed Reading
Injections

The Royal Pharmaceutical Society


Beaney AM., Black A., Dobson C.R. Williamson R.M Robinson M. (2005) http://www.pjonline.com/pdf/hp/200504/hp_200504_riskassessment.pdf
Development and application of a risk assessment tool to improve the safety
of patients receiving injectable medicines, Hospital Pharmacist,150-154.

The Office of Public Sector Information


Statutory Instrument 1988 No. 1657. http://www.opsi.gov.uk/si/si1988/Uksi_19881657_en_1.htm
The Control of Substances Hazardous to Health Regulations 1988
Edinburgh:Crown.

Nursing Standard
Gould D. (2000) Hand decontamination, Nursing Standard, 15 (6), 45-50. www.nursing-standard.co.uk

Professional Nurse
Keirnan, M. ( 2003) Reducing the risks of device-related infection caused by http://www.professionalnurse.net/
staphylococci. Nursing Standard, 18 (8), 441-444.

CARDS
Centre for Adverse Reactions to Drugs (Scotland) Yellow Card Centre Scotland
http://www.yccscotland.scot.nhs.uk/

14
Underpinning Knowledge for Specific Competencies

Competency 2.1
Local policies/guidance for the :

 Preparation of injections (dilutions & the reconstitution process)


 Administration of medicines
 Administration of infusions (e.g. operation of devices, rates of
administration, suitable diluents

Competency 2.4 Local policies and procedures relating to the management of injection related
hazards e.g.:
 Blood spillage
 Needle stick injuries
 Infection control

Competency 2.5 Local policies and procedures relating to the management of hazards

Beaney A.M. (ed) (2005) Quality Assurance of Aseptic Preparation Services


th
(4 Edition) Pharmaceutical Press: London.

Competency 2.6 Local policies and procedures relating to the :


 Administration of multiple medicines
 Management of the injection site
 Assurance of line patency
 Management of extravasation/infiltration/anaphylaxis/phlebitis
 Control of infection
 Therapeutic drug monitoring
 Management of respiratory depression

Koerner R.J., Morgan S. (1977) Outbreak of Gram negative septicaemia


caused by contaminated continuous infusions prepared in non - clinical
areas. Journal of Hospital Infection, 36:285-289.
Rowley, S. (2001) Aseptic non - touch technique. Nursing Times, 97(7).

15
Section A
Competency Framework
Topic 2: Hazards Involved in the Preparation and Administration of Injections

Learning Outcomes Learning Method How Competence is Assessed

2.1
Be able to assess, plan, implement, Directed reading + Completion of individual professional CPD record + Written Report or Testimonial
evaluate and prioritise the most suitable Local course for the preparation of during period of supervised practice
route of administration of a medicine injections
depending on individual patient
requirements/clinical condition

2.2
Be able to describe the different routes Directed reading + Completion of individual professional CPD record + Written Report or Testimonial
of administration (inc. a variety of Local course for the preparation of during period of supervised practice
different formulations) injections
Be able to describe at least two
advantages and two disadvantages of
administering medicines by each of the
different routes

2.3
Be able to describe the referral Local course for the preparation of Completion of risk assessment during period of supervised practice
mechanism for ‘high risk’ medicines that injections + Supervised practice
are not suitable to be prepared within
the near-patient area

2.4
Be able to identify and discuss the Directed reading + Testimonial following assessment during period of supervised practice
management of , a variety of hazards Local course for the preparation of
that may affect the practitioner /others injections
during the preparation of an injection.

16
2.5
Be able to identify a variety of potential Directed reading + Testimonial following assessment during period of supervised practice +
hazards that may affect the patient Local course for the preparation of Completion of risk assessment during period of supervised practice
receiving the medication injections

2.6
Be able to describe potential hazards Directed reading Testimonial following assessment during period of supervised practice
that may occur during the administration
of an injection. Be able to discuss the
management of such hazards.

2.7
Be able to identify the correct handling and Local course for the preparation of Testimonial following assessment during period of supervised practice
storage of medicines and be able to injections
describe at least 3 hazards and their
management, that may occur when
medicines are stored out with the clinical
environment

2.8
Be able to discuss the local and national Local course for the preparation of Testimonial following assessment during period of supervised practice
procedure for the reporting of a suspected injections
adverse drug reaction

17
Section A
General Underpinning Knowledge
Topic 3

Topic 3: Calculations and Checking Procedures During the Preparation General Underpinning Knowledge/Directed Reading
of Injections

The British National Formulary


Intravenous Additives http://www.bnf.org/bnf/bnf/current/37408.htm

The Electronic Medicines Compendium


http://emc.medicines.org.uk/emc/industry/default.asp?page=displaydoc.asp&
documentid=2041

Medication Dosage Skills Online http://authenticworld.co.uk/products/mdcs/mdcs.php


The Faculty of Health and Social Care at the University of the West of
England, Bristol.
Online Numeracy Skills Support Material
http:/learntech.uwe.ac.uk/numeracy/
Nursing Standard
Quick Reference Guide 1 ( Numeracy Skills)
Quick Reference Guide 2 (Calculating Drug Dosage)

Underpinning Knowledge for Specific Competencies

Competency 3.1 Local policies/procedures for the assessment of calculations

Lapham R., Agar H. (2003) Drug Calculations for Nurses: a step- by- step
approach, London: Arnold.

Competency 3.2 Local policies and procedures for the administration of medicines by infusion
pump.

18
Section A
Competency Framework
Topic 3: Calculations and Checking Procedures During Preparation of Injections

Learning Outcomes Learning Method How Competence Assessed

3.1
Be able to calculate doses correctly Directed reading + Individual assessment by completion of calculations prior to supervised practice (e.g.
assessment to agreed local standard)
Completion of calculations through +
examples and assessment Assessment during period of supervised practice
+ +
1 : 1 support /group support Completion of individual professional CPD record
(if required)

3.2
Be able to describe the principles of Directed reading + Testimonial following assessment during period of supervised practice
safe administration of medicines via
an infusion pump and be able to Local course for the preparation of
demonstrate the safe administration of injections +
a drug via an infusion pump
Period of supervised practice

3.3
Demonstrate a systematic approach Directed reading + Testimonial following assessment during period of supervised practice
to the preparation of injections and be Local course for the preparation of
able to describe the various checks injections
that are required to be undertaken to
ensure that the product (injection) is
prepared according to standard
procedures

19
Section A
General Underpinning Knowledge
Topic 4

Topic 4: Drug Incompatibilities General Underpinning Knowledge/Directed Reading

The British National Formulary


Appendix 1: Interactions http://www.bnf.org/bnf/bnf/current/41001.htm

Underpinning Knowledge for Specific Competencies

Competency 4.1 Injectable Drug Administration Guide Published by UCL Hospitals

Trissel L., Handbook on Injectable Drugs: The American Society of Health-


System Pharmacists (ASHP).
Competency 4.2 Local and national monographs for medicines

Local procedures for the safe and secure handling of medicines

Pickstone M., (1999) A pocket book for safer IV therapy (Drugs, Giving sets
and Infusion pumps). Scitech Educational, Margate.

20
Section A
Competency Framework
Topic 4: Drug Incompatibilities

Learning Outcomes Learning Method How competence is assessed

4.1
Be able to :

i) recognise and discuss potential drug Directed reading + Testimonial following assessment during period of supervised practice
interactions and incompatibilities Local course for the preparation of +
injections + Consider practical Written report
ii) identify reference sources that detail: demonstration/video
drug-drug incompatibilities, drug fluid
incompatibilities and fluids to which
drugs should not be added when
they are being administered

4.2
Be able to discuss the various factors that Local course for the preparation of Testimonial following assessment during period of supervised practice
may dictate the volume of the diluent injections
used when preparing an injection

21
Section A
General Underpinning Knowledge
Topic 5

Topic 5 : The Stability of Prepared Injections General Underpinning Knowledge/Directed Reading

The British Medical Journal


Taxis K., Barber N. (2003) Ethnographic study of incidence and severity of http://www.bmj.com/cgi/reprint/326/7391/684?maxtoshow=&HITS=10&hits=1
intravenous drug errors. The British Medical Journal, 326-684. 0&RESULTFORMAT=&fulltext=Taxis+K.%2C+

The British National Formulary


Appendix 6: IV Additives http://www.bnf.org/bnf/bnf/current/37408.htm

Section A
Competency Framework
Topic 5: The Stability of Prepared Injections

Learning Outcome Learning Method How competence is assessed

5.1
Be able to describe the factors that Directed reading + Testimonial following assessment during period of supervised practice
influence the stability of an injection when Local course for the preparation of +
prepared and administered in a near – injections Completion of individual professional CPD record
patient area

22
Section A
General Underpinning Knowledge
Topic 6

Topic 6 : Displacement Values General Underpinning Knowledge/Directed Reading

The British National Formulary


Appendix 6: IV Additives http://www.bnf.org/bnf/bnf/current/37408.htm

Underpinning Knowledge for Specific Competencies

Competency 6.1 Lapham R., Agar H. (2003) Drug Calculations for Nurses: a step- by- step
approach. London, Arnold.

Section A
Competency Framework
Topic 6: Displacement Values
Learning Outcomes Learning Methods How competence is assessed

6.1
Be able to discuss the meaning of the Theoretical education programme Testimonial following assessment during period of supervised practice
term ‘displacement value’ and +
demonstrate safe, effective and consistent Completion of individual professional CPD record
numerical ability when calculating
displacement values (Cross Ref Topic 3-
Calculations)

23
Section A
General Underpinning Knowledge
Topic 7

Topic 7 : Aseptic Technique for the Preparation of Injections General Underpinning Knowledge/Directed Reading

The British Medical Journal http://www.bmj.com/cgi/reprint/326/7391/684?maxtoshow=&HITS=10&hits=1


Taxis K., Barber N. (2003) Ethnographic study of incidence and severity of 0&RESULTFORMAT=&fulltext=Taxis+K.%2C
intravenous drug errors. The British Medical Journal, 326-684.

The British National Formulary


Appendix 6: IV Additives http://www.bnf.org/bnf/bnf/current/37408.htm

Nursing Standard
Lavery I., Paula I. (2006) Prevention of infection in peripheral intravenous www.nursing-standard.co.uk
devices. Nursing Standard, (49): 49-56.

Underpinning Knowledge for Specific Competencies

Competency 7.1 Local policies and procedures relating to aseptic technique

The Scottish Executive Health Department (2002) Good Practice


Statement for the Preparation of Injections in Near-Patient Areas, Including
Clinical and Home Environments. Appendices 5 and 7, Edinburgh:SEHD.

http://www.scotland.gov.uk/Publications/2002/12/16049/15908

The Royal Marsden Hospital Manual of Clinical Nursing Procedures. Chapters 4, 9 &
th
11. 6 Edition. Blackwell Publishing. Oxford 2004

24
Section A
Competency Framework
Topic 7: Aseptic Technique for the Preparation of Injections

Learning Outcomes Learning Method How Competence is Assessed

7.1
Be able to discuss the procedure to Local course for the preparation of Testimonial following assessment during period of supervised practice +
prepare injections aseptically and be able injections + Completion of individual professional CPD record
to demonstrate the effective adherence to Period of supervised practice
aseptic principles when preparing
injections

25
Section A
General Underpinning Knowledge
Topic 8

Topic 8 : Standard Preparation Methods for the Preparation of Injections General Underpinning Knowledge/Directed Reading

The National Patient Safety Agency (2007)


Promoting safer use of injectable medicines: http://www.npsa.nhs.uk/site/media/documents/2476_Inject_SOP.pdf
A template standard operating procedure for: prescribing, preparing and
administering injectable medicines in clinical areas.

Underpinning Knowledge for Specific Competencies

Competency 8.2 Local and national drug monographs


Local formularies and treatment protocols

Competency 8.3 The British National Formulary


Appendix 6: IV Additives
http://www.bnf.org/bnf/bnf/current/37408.htm

Competency 8.4 Local policies/procedures for the disposal of:


 Waste
 Needles and syringes
 Ampoules and vials

26
Section A
Competency Framework
Topic 8: Standard Preparation Methods for the Preparation of Injections

Learning Outcomes Learning Method How Competence is Assessed

8.1
Be able to demonstrate the agreed Directed reading + Simulation during theoretical educational session +Testimonial following assessment
standard procedure for the preparation Local course for the preparation of during period of supervised practice + Completion of individual professional CPD record
of an injection injections + Period of supervised
practice

8.2
Be able to define the term ‘Ready to Directed reading + Testimonial following assessment during period of supervised practice
Use’ injection and discuss the rationale Local course for the preparation of +
for the prescribing of injections in a injections Completion of individual professional CPD record
‘Ready to Use’ form in preference to
prescribing injections that require to be
manipulated prior to administration

8.3
Be able to identify reference sources Directed reading + Testimonial following assessment during period of supervised practice +
that provide supportive guidance on Local course for the preparation of Completion of individual professional CPD record
standard doses and concentrations of injections
injectable medications
(Cross Ref with topic 13)

8.4
Be able to discuss the local procedure Directed reading + Testimonial following assessment during period of supervised practice +
for the safe disposal of clinical waste Local course for the preparation of Completion of individual professional CPD record
following the preparation of an injection injections
and demonstrate the consistent
adherence to local policies and
procedures
(Cross Ref with topic 12)

27
Section A
General Underpinning Knowledge
Topic 9

Topic 9 : Checking Procedures Prior to and During Administration of General Underpinning Knowledge/Directed Reading
Injections

The National Patient Safety Agency http://www.npsa.nhs.uk/site/media/documents/2602_0434_injectables_meds


Promoting safer use of injectable medicines: Patient safety alert 20, London _alert_v20.pdf

The National Extravasation Service http://www.extravasation.org.uk/home.html

The Resuscitation Council (UK) http://www.resus.org.uk/SiteIndx.htm

Underpinning Knowledge for Specific Competencies

Competency 9.1 Local procedures and policies for the:

 Checking of patients prior to the administration of medicines


 Assessment of patients during and after the administration of an
injection
Competency 9.2 Local procedures and policies for the :

 Management of anaphylaxis
 Management of cardiopulmonary resuscitation
 Management of extravasation
 Reporting of adverse event/medication incidents

28
Section A
Competency Framework
Topic 9: Checking Procedures Prior to and During Administration of Injections

Learning Outcomes Learning Methods How Competence is Assessed

9.1
Be able to describe the procedures for Directed reading + Local course for Testimonial following assessment during period of supervised practice +
the assessment of the patient prior to and the preparation of injections Completion of individual professional CPD record
during the administration of an injection to
minimise the risks to patients

(Cross Ref with topic 2.1)

9.2
Be able to describe the effective Directed reading + Testimonial following assessment during period of supervised practice
identification and management of an Local course for the preparation of
adverse event/medication incident that injections
occurs during the administration process

(Cross Ref with topic 2.6)

29
Section A
General Underpinning Knowledge
Topic 10

Topic 10 : Documentation for the Preparation and Administration of General Underpinning Knowledge/Directed Reading
Injections

The Nursing and Midwifery Council


Guidelines for Records and Record Keeping Guidance 01 05 Published 2005 http://www.nmc-uk.org/aFrameDisplay.aspx?DocumentID=516

Underpinning Knowledge for Specific Competencies

Competency 10.1 Local procedures and policies for the recording of the:
 Prescribing of injections
 Administration of injections

Section A
Competency Framework

30
Topic 10: Documentation for the preparation and administration of medicines

Learning Outcomes Learning Methods How Competence is Assessed

10.1
Demonstrate Local course for the preparation of Testimonial following assessment during period of supervised practice
injections
i) effective record keeping in
relation to the administration of
injectable medications and the
consistent accurate completion of
documentation

ii) Be able to discuss the documentation


used by different members of the

healthcare team during the preparation


and administration of an injection

31
Section A
General Underpinning Knowledge
Topic 11

Topic 11 : Labelling Requirement for Injections General Underpinning Knowledge/Directed Reading

Hospital Pharmacist
Millar A., Hughes D., Kerr S., et al.(2006) The safe preparation of injections in http://www.pjonline.com/pdf/hp/200604/hp_200604_injections.pdf
near -patient areas, Hospital Pharmacist,13 128-131.

Underpinning Knowledge for Specific Competencies

Competency Local procedures and policies for the labelling of injections

Section A
Competency Framework
Topic 11: Labelling Requirements for Injections

Learning Outcomes Learning Methods How Competence is Assessed

11.1
Be able to prepare and label an Directed reading Testimonial following assessment during period of supervised practice
injection according to local and +
national guidance Local course for the preparation of injections

32
Section A
General Underpinning Knowledge
Topic 12

Topic 12 : Disposal of Waste, Including Medicines, Containers and General Underpinning Knowledge/Directed Reading
Sharps

Hospital Pharmacist

Millar A., Hughes D., Kerr S., et al.(2006) The safe preparation of injections in http://www.pjonline.com/pdf/hp/200604/hp_200604_injections.pdf
near -patient areas, Hospital Pharmacist,13 128-131.

Underpinning Knowledge for Specific Competencies

Competency 12.1 Local procedures and policies for the:

 Disposal of needles
 Disposal of syringes
 Disposal of ampoules and vials

33
Section A
Competency Framework
Topic 12: Disposal of Waste, Including Medicines, Containers and Sharps

Learning Outcomes Learning Methods How Competence is Assessed

12.1
Be able to describe the procedures for the Directed reading + Testimonial following assessment during period of supervised practice +
safe disposal of clinical and non - clinical Local course for the preparation of Completion of individual professional CPD record
waste following the injections
preparation/administration of an injection

(Cross ref with topic 8.4)

34
Section A
General Underpinning Knowledge
Topic 13

Topic 13 : Product Monographs General Underpinning Knowledge/Directed Reading

The British National Formulary


Appendix 6 IV additives http://www.bnf.org/bnf/bnf/current/37408.htm

Underpinning Knowledge for Specific Competencies

Competency 13.1 Local procedures and policies for the Safe and Secure Handling of Medicines

Section A
Competency Framework
Topic 13: Product Monographs

Learning Outcomes Learning Methods How Competence Assessed

13.1
Be able to describe the reference Directed reading Testimonial following assessment during period of supervised practice +
sources required when preparing an + Completion of individual professional CPD record
injection Local course for the preparation of
injections
(Cross Ref with topic 8.3)

35
Section A
General Underpinning Knowledge
Topic 14

Topic 14 : Awareness of Control of Substances Hazardous to Health, General Underpinning Knowledge/Directed Reading
and Other Health and Safety Considerations

The Office of Public Sector Information


Statutory Instrument 1988 No. 1657. http://www.opsi.gov.uk/si/si1988/Uksi_19881657_en_1.htm
The Control of Substances Hazardous to Health Regulations 1988
Edinburgh:Crown.

Underpinning Knowledge for Specific Competencies

Competency 14.1 Local procedures and policies for:

 Health and Safety


 The Administration of Medicines

Competency 14.3 The NPSA Risk Assessment Tool


http://www.npsa.nhs.uk/site/media/documents/2475_Inject_Risk_assess.doc

36
Section A
Competency Framework
Topic 14: Awareness of Control of Substances Hazardous to Health, and Other Health and Safety Considerations

Learning Outcomes Learning Methods How Competence Assessed

14.1
i) Be able to describe a range of health Directed reading + Testimonial following assessment during period of supervised practice +
and safety issues (hazards) that may Local course for the preparation of Completion of individual professional CPD record
arise during the preparation of an injections
injections

ii) Be able to evaluate and prioritise other


routes of administration in the event of
being unable to administer the medicine
to the patient by injection

(Cross Ref with topic 2 )

14.2
Be able to identify any actions required Directed reading + Testimonial following assessment during period of supervised practice
to minimise risk to the practitioner and the Local course for the preparation of
environment when the injection is being injections
prepared

37
14.3
Be able to discuss the procedure for Local course for the preparation of Testimonial following assessment during period of supervised practice
completion of a risk assessment in order to injections
determine the most appropriate location for
the preparation of an injection

N.B. Where preparation will occur with the


clinical environment ( i.e. in the patient’s home),
then a risk assessment needs to be undertaken
prior to the patient being discharged from
hospital

14.4
Be able to identify the reasons for the Directed reading + Testimonial following assessment during period of supervised practice +
preparation of ‘high risk medicines’ by Local course for the preparation of Completion of individual professional CPD record
specially trained pharmacy staff (e.g. injections
pharmacy staff in an aseptic dispensing
facility) and be able to identify at least 2
injections that would be unable to be
prepared within the near- patient area
(i.e. high risk injections)

14.5
Be able to describe the rationale for the Directed reading + Assessment during period of supervised practice
immediate administration of injections Local course for the preparation of
that have been prepared in the near – injections
patient area

38
Section B

Examples of practice occurring throughout Scotland as part of the ‘scoping exercise’ undertaken for
development of this guidance document

Topic Examples of Practice Identified

Topic 1 Responsibilities of staff


The provision of theoretical educational sessions/local courses for the preparation of injections that inform of
the :
o Legal & professional requirements and regulations
o Liability issues
o Requirement for practitioners to regularly undertake CPD

Organisations that provide:


o An agreed length of accreditation following education intervention/attendance at a local course e.g.
accreditation for 2 years with processes in place for re accreditation after this period and where there
is also a process for the re- accreditation of practitioners after a break in practice. (break >12months)

o Guidance relating to minimum grade of staff who should achieve competence in the preparation of
injections in near-patient areas
o Refresher courses
o A standard framework for the period of agreed supervised practice
o A competency framework for completion prior to, during and after the educational session
o A supervised practice standards (e.g. the practitioner needs to prepare each form of injection an
agreed number of times (e.g .five times), prior to being signed off as competent in the workplace (e.g.
minimum of 10 injections within a 4 week period)
o A standard framework available for recognition of practitioners accredited as competent to prepare
injections in near-patient areas
o Central recording of all practitioners registered to practice, with the individuals date of
re - accreditation detailed

39
Section B

Topic Examples of Practice Identified

Organisations where:
Topic 3 Calculations and checking o Practitioners ‘practise’ calculations prior to attending the educational session
procedures prior to o The calculations required to be completed for accreditation are available on CD ROM/on line for and
preparation may be completed prior to the session
o There are procedures in place to ensure that practitioners receive feedback on performance in
completion of calculations prior to attendance at an educational session
o There is an agreed pass mark of 100% and where there are procedures to support practitioners who
do not achieve the pass mark
o Further calculations are undertaken as part of a ‘refresher’ training/process after initial accreditation
Topic 4 Drug Incompatibilities Organisations where the educational sessions:
o Inform of the pharmacology of an agreed list of ‘core’ medicines
o Inform of the pharmacokinetics of drugs with a narrow therapeutic range
o inform of antibiotics and sensitivities to certain medicines
o Specialists are involved in delivery of relevant parts of the session
(i.e. pharmacy staff, infection control specialists etc.)
Topic 7 Aseptic Technique Organisations where:
o Practitioners are given the opportunity to undertake simulated preparation of an injection prior to a
period of agreed supervised practice

40
Topic 14 Organisations where the educational session informs of:
Awareness of Control of
Substances Hazardous to o The differences in the nature of medicines and the reasons why hazardous/high risk complex
Health and other Health medicines must be made up by appropriately trained pharmacy personnel (e.g. parenteral nutrition,
and Safety Considerations chemotherapy)

o The principles of COSHH and details some of the hazards involved in the preparation of medicines
and how to minimise any risks that may occur during the preparation and administration of the
medicine. Such hazards may be to the practitioner or to the patient (if standard procedures
are not followed)

o The role of the practitioner, the procedure for the completion of a risk assessment in order
To determine the level of risk associated with the medicine

Organisations where there is standard documentation for undertaking a risk assessment, that is widely
available to practitioners and which guides the practitioner to the most appropriate location for preparation of
the medicine (There are procedures for referral to pharmacy for the preparation of high risk / complex
medicines (e.g. chemotherapy, parenteral nutrition (PN)).

41
Section C

Examples of the minimum information that should be included in an educational programme

Competency 1.7 Information that details at least three routes of administration:

○sc ○im ○iv

Competency 1.10 Information that will enable demonstration of knowledge of :

○ the desired effects of the medicine/ potential side effects


of the medicine

○ the reporting of adverse events and medication incidents


○ the administration of infusions

Competency 2.1 Information pertaining to patients who are:

○ elderly ○ malnourished ○ immunocompromised ○ suffering from skin loss


( e.g. burns) ○ receiving other medication (e.g. antibiotics)
○ receiving post operative pain control/palliative care

Information pertaining to patients who have:

○ systemic diseases (e.g. diabetes, cardiovascular, renal disease,


hepatic disease etc) ○major organ failure/ widespread infection
(e.g. sepsis).

N.B. This list is not exhaustive.

Competency 2.2 Information that provides knowledge of different routes of administration:

○ iv bolus ○ iv continuous infusion ○ iv intermittent infusion


○ im injection ○ sc injection ○ sc infusion

N.B. This list is not exhaustive

42
Competency 2.4 Information that details the following hazards:

○ aerosol generation ○ blood spillage ○ glass cuts ○ blood contamination


○ self contamination with medicine ○ drug & fluid spills ○ needle stick injuries
○ infection control

Competency 2.5 Information that highlights the implications of incorrect:

○ drug selection ○hand washing technique


○ method of preparation ○dosage calculation ○ diluent selection

Competency 2.5 Information that highlights the implications of:

○ poor aseptic technique ○ incompatibility of constituents (drug/drug,


drug/fluid)
○ instability of the final product ○ contamination (microbiological and
particulate) ○ an unsuitable environment for preparation of the injection

Competency 2.6 Information that informs of hazards that may affect the medicine that is being
administered:

○ the administration of multiple other medication ○ blockage of the


administration line ○ long term placement of devices/lines (e.g. >72 hours)
○ the achievement of inappropriate therapeutic drug levels
○ spillage due to leaky equipment

Competency 2.6 Information that informs of hazards that may affect the patient during
administration of the medicine e.g. the signs and symptoms of:

○ infection, anaphylaxis, extravasation, respiratory depression, phlebitis,


infiltration, haematoma formation, infusing certain medicines over too short
a timescale

Competency 2.7 Information that informs of some potential hazards that may be encountered
within a patient’s home or a GP’s surgery

43
Competency 3.1 Information that describes how to calculate:

○ the volume to be administered ○ unit conversions (mg, micrograms etc.)


○ percentages (%) volume by volume (v/v) , weight by volume (w/v)
○ dilutions ○ ratios ○ displacement values ○ calculations
(infusion concentrations, rates and infusion times)

Competency 3.2 Information that describes:

○ a range of infusion pumps available locally

Competency 3.3 Information that describes a standard method of preparation and informs of
the in process checks required to ensure :

○ the final product is suitable for administration


○ the appropriate expiry date of the drug , the appropriate expiry date of the
finally prepared medicine ○ that the label contains the correct information

Competency 4.1 Information pertaining to reference sources that inform of:

○ drug-drug interactions ○drug-diluent interactions

○drug-drug compatibilities / incompatibilities


○drug- fluid compatibilities / incompatibilities
○drug -container incompatibilities (adsorption, crystallisation,
permeation)

○fluids to which drugs should not be added when they are being
administered (e.g. parenteral feeding fluids, enteral feeding fluids or blood
products)

Competency 4.2 Information that informs of factors that influence the volume of fluid that may be added
to a medicine:
○route of administration ○displacement volumes ○required final concentration
of the product ○the dose of the drug required

44
Competency 5.1 Information that informs of factors that influence the stability of an injection:

○ incompatibilities with fluid / container / drug ○ pH of product


○ the environment (light /temperature) ○ time scale for administration of the
injection
N.B. The product should be administered immediately following preparation.

Competency 7.1 Information that informs of the importance of aseptic technique :

○ sources of contamination ○ infection control (Cross ref Topic 1)


○ assurance of sterility(asepsis) (inc. timescales for preparation and
administration)

Competency 8.1 Information that details the standard preparation for injections

○ ampoules ○ vials ○ diluents ○ syringes ○ needles ○ filters

Competency 8.4 Information that informs of the procedures and policies relating to the
disposal of waste in particular the different :

○ for disposal different types of waste- hazardous and non- hazardous


○sharps (needles) ○ non sharps (syringes amps + vials iv bags)

Competency 9.1 Inform of procedures for assessment of the patient prior to and during
administration of the medicine:

○ patient’s identification number ○prescriber’s signature ○the approved


medicine name and the formulation of the medicine
○the dose and frequency of administration ○the date and
route of administration ○the patient’s age, allergy status, weight , fluid
balance, renal, liver and cardiac function
○ the suitability of medicine and dose based on patient’s physiological status
○ the correct date and time of administration (avoidance of duplication of
dosing) ○the concentration or total quantity of the medicine in the final

45
infusion container/syringe ○name and volume of diluent/infusion fluid ○the
rate and duration of administration ○the date on which treatment should be
reviewed ○the the type of device to be used for administration of the
medicine

Competency 9.2 Information that informs of the management of:


○ anaphylaxis, ○ the unconscious patient○ extravasation
○ phlebitis e.g. Jackson scoring tool ○ faulty equipment during the
administration process

Competency 10.1 Information that informs of documentation for :


○ the prescribing of ,and the administration of, medicines
○ the monitoring of the administration of infusions
○ the monitoring of patients receiving drugs with a narrow therapeutic
range

Competency 11.1 Information that informs of the labelling requirements:


○ the date of preparation ○ the name of the medicine ○the intended route of
administration
○ the dose of the medicine ○the final volume of the product
○ expiry time of the final product ○ the name of diluent
○ time of addition of the medicine to the diluent
○ the final concentration (strength) of the product/infusion
○ the patient’s name ○ the initials of the practitioner preparing the product
○ the initials of the practitioner ‘checking’ the product (if appropriate)
N.B. This list is not exhaustive

Competency 14.1 Information that informs of the different routes of administration:


○ oral route, enteral tube feeding route, rectal route etc.

Competency 14.1 Information that informs how to ensure the health and safety of self and
others:
○ minimisation of risks/hazards to the environment
○ minimisation of risks/hazards to the operator

46
Competency 14.3 Information that informs of processes, procedures and documentation
associated with a risk assessment :

○ high risk medicines ○low risk medicines


○chemotherapy ○ parenteral Nutrition (PN)

N.B. Where preparation will occur with the clinical environment ( i.e. in the patient’s home), then
a risk assessment needs to be undertaken prior to the patient being discharged from hospital.

Competency 14.5 Information that conveys the rationale for the immediate administration of medicines
when prepared in the clinical environment:

○to avoid contamination


○to ensure stability of the product during the period of administration

47
Acknowledgements

The group wish to acknowledge the help of all involved in the consultation exercise and in particular the support provided from; the Chief Nurses, NHS Quality
Improvement Scotland, the pharmacy aseptic specialist interest group (ASSIG) and the various practitioners who submitted training programmes and
supporting documentation as part of the project.

Particular thanks to Linda Russell, Senior Pharmacy Technician, Queen Margaret Hospital, Fife, for development of the questionnaire and collation of the
various documents up until June 2005.

48
Appendix I
References

1. Scottish Executive Health Department (2002) Good Practice Statement for the Preparation of Injections in Near-Patient Areas, Including Clinical and
Home Environments, Edinburgh: SEHD.

2. Scottish Executive Health Department (2002) HDL 91 Good Practice Statement for the Preparation of Injections in Near-Patient Areas, Including Clinical
and Home Environments, Edinburgh: SEHD.

3. NHS Education for Scotland (2004) Transferring the Skills: Quality assurance framework for venepuncture, cannulation and intravenous therapy (draft),
Edinburgh, NES.

4. Millar, A. Hughes, D. Kerr, S. et al. (2006) The safe preparation of injections in near-patient areas. Hospital Pharmacist,13, 128-131.

5. The National Patient Safety Agency website. Patient Safety Alert 20.(2007) Promoting safer use of injectable medicines.

http://www.npsa.nhs.uk/site/media/documents/2602_0434_injectables_meds_alert_v20.pdf Accessed August 2007

49
Appendix II
Glossary of Terms 1,5

5
Administration devices Medical devices designed to regulate or control, mechanically
or electronically, the administration of injections or infusions of
medicines
1
Aseptic dispensing The preparation of a medicine that is appropriate for issue or
administration to a patient, by a method of handling sterile
material that employs techniques which minimise the risk of
microbial contamination
5
Aseptic technique Handling technique designed to minimise the risk of microbial
contamination of a sterile medicine during preparation

5
Bolus (push)
Administration from a syringe of a small volume of a single
dose of a sterile solution directly into a tissue, organ or vein,
over a short time of, usually, between 30 seconds and
10minutes
5
Clinical areas
Wards, clinical departments, operating theatres, clinics, GP
surgeries. In the context of home care, the term may also be
considered to include the patient’s home
5
Diluent Any sterile injection solution, such as water for injection or
sodium chloride 0.9%, commonly used to dissolve
(reconstitute) or dilute a medicine immediately before
administration

50
5
Hazard Any factor, such as a difficult procedure or a complex
calculation, with the potential to cause harm if carried out
incorrectly

1
High Risk Where the hazard associated with preparation is likely to have
serious consequences for the patient or operator

5
Infusion Administration, from a syringe or other rigid or collapsible
container e.g. plastic bag, of a volume of sterile solution of an
injectable medicine directly into a tissue, organ or vein or
artery, at a constant rate, under gravity or by means of an
electronic or mechanical pump or other means of rate control,
over a defined period usually of at least 10 minutes

5
Injectable medicines Sterile medicines intended for administration by bolus injection,
perfusion or infusion by any of the following routes:
intravenous, intramuscular, intrathecal, intra - articular,
subcutaneous, intradermal, intraventricular, epidural,
intravesicular, intravitreal, intrapelural and intraocular

1
Licensed manufacturer Possessing a licence from the Licensing Authority (the
Medicines Control Agency) to operate as a manufacturer of
pharmaceutical products

1
Low risk Where the hazard associated with preparation is unlikely to
have serious consequences for the patient or operator

1
Multi – professional Doctors, nurses, pharmacists and other healthcare
professionals involved with prescribing, preparing or
administering injectable medicines

51
1
Near – patient area (s) The general area in which the patient is examined, treated and
cared for e.g. the ward, the clinic or surgery, the patient’s
home

1
Parenteral Administered by injection, infusion or implantation into the
body

1
Preparation The manipulation of ingredients and components to make a
final product

5
Ready – to- administer injectable products These products require no further dilution or reconstitution and
are presented in the final container or device, ready for
administration or connection to a needle or administration set.
For example, an infusion in a bag with no additive required

5
Ready – to use injectable products These products require no further dilution or reconstitution
before transfer to an administration device. For example, a
liquid with an ampoule, of the required concentration, that only
needs to be drawn up into a syringe

52
Appendix III
Membership of Steering and Reference Groups

Project Manager: Fiona McMillan, Lead Pharmacist, Educational Development, Pharmacy,


NHS Education for Scotland
Project Leader: Anne Watson, Assistant Director of Pharmacy, NHS Education for Scotland.

Membership of the Steering Group


Dorothy Armstrong Programme Director
Nursing, Midwifery and Allied Healthcare Professionals
NHS Education for Scotland, Edinburgh

Dorothy Hughes Deputy Chief Pharmacist


Acute Division, NHS Lothian

Alna Robb Head of Practice Development


(Until June 2006) NHS Quality Improvement Scotland, Glasgow

Membership of the Reference Group

Penny Bond Diane Allcock


Professional Practice Development Officer Nursing Representative
NHS Quality Improvement Scotland, Edinburgh Professional Practice Development Nurses Forum (PPDNF)
Scotland

Andrew Parker Senior Pharmacist Prof Jim McKillop


Representative, Aseptic Services Specialist Interest Group (ASSIG) Dean of The Faculty of Medicine, Glasgow University
Queen Margaret Hospital, NHS Fife Glasgow

53
Marina Shannon Dr David McQueen
Practice Development Specialist, Critical Care and Theatres, Post Graduate and Foundation Tutor, NHS Forth Valley
NHS Lanarkshire

Linda Russell Alexa Wall


(until October 2005) Principal Pharmacist, NHS Lanarkshire
Senior Pharmacy Technician
Queen Margaret Hospital, NHS Fife

Elaine Traynor Ruth Forrest


Practice Development Nurse Senior Pharmacist
South Glasgow Hospitals, NHS Greater Glasgow & Clyde Representative Quality Assurance Specialist Interest Group
/(QASIG), Glasgow
st
From 1 September 2006 Marianne Fairley

Mike Sabin John Stuart


Programme Director Head of Nursing
Nursing, Midwifery and Allied Health Professions Regional Services, NHS Greater Glasgow and Clyde
NHS Education for Scotland, Edinburgh

Kate Lambie Jim Foulis


Nursing Representative Associate Director or Nursing
Professional Practice Development Nurses Forum (PPDNF) Tayside Hospitals, NHSTayside
st
From 1 September 2006 Joyce Surfleet

Charles Sinclair
Head of PPDNU
Operational Division, NHS Fife

54
Appendix IV
Respondents to the Consultation

Name Organisation

M Haggerty South West Community Health and Care Partnership (SWCHCP)

M Russell NHS Lanarkshire

J Surfleet Professional Practice Development Nurses Forum (PPDNF)

B Jappy Pharmacy, NHS Grampian

M Caldwell Ayrshire & Arran Drug and Therapeutics Committee

A Wilson NHS Dumfries and Galloway

C Sinclair NHS Fife

P Jones NHS Lothian APC

M Connolly Practice Development (Acute) GGHB

55
E Noble NHS Borders

D Corner Acute Service Division Pharmaceutical NHS Tayside

C McLaughlin NHS Greater Glasgow & Clyde

A Mitchell South East Scotland Neonatal Transport

P Ingram NHS Lothian (Clinical Skills)

R Pirie Learning Disabilities (Scotland)

M Kean The Southern General Regional Services (ITU)

56
NHS Education for Scotland
rd
3 Floor
2 Central Quay
89 Hydepark Street
Glasgow
G3 8BW

Tel: 0141 223 1600


Email: pharmacy@nes.scot.nhs.uk
Website: www.nes.scot.nhs.uk

August 2007.

57

You might also like